Having the right conversation
Talking to an expert is often a critical behaviour change intervention: we need to consider carefully how to get this right
“... there are known knowns; there are things we know that we know. There are known unknowns; that is to say, there are things that we now know we don't know. But there are also unknown unknowns – there are things we do not know we don't know.”
The former US Secretary of Defence Donald Rumsfeld famously made his comment at a press briefing in 2002, where he addressed the absence of evidence linking the government of Iraq with the supply of weapons of mass destruction to terrorist groups. Opinion was divided on his comment at the time, earning him the 2003 Foot in Mouth Award while Canadian columnist Mark Steyn, called it "a brilliant distillation of quite a complex matter”.
Perhaps the ‘Donald Rumsfeld question’ is a useful way for us to think about ways to empower people to have the right conversations, particularly when talking to an expert. We all need to talk to an expert at times, whether a doctor, financial advisor, solicitor, accountant, the sales-advisor for a complex product and so on. In our work we often identify that the point of engagement with an expert is critical to behaviour change. One good case in point that is very current is the way a doctor talks to a patient about vaccination, it is long know that this is an important predictor of take-up.
However, as we can see from the Rumsfeld point, interactions between laypeople and experts it not always easy. In the case of the doctor-patient relationship the patient will have things that they know they know, others that they know they don’t know but also things that they don’t know they don’t know. So the patient may have quite a bit of uncertainty going into the consultation which means they may not know what questions to ask or how to understand information which is given to them. Added to this, the expert is necessarily a limited and expensive resource which means that available contact is limited and the layperson may feel intimidated and anxious.
So, what guidance does behavioural science have? One of the key considerations is to understand the mental schema that people may have entering that conversation. The patient may think of vaccines as treatments rather than protection, or they could be confused about the need for a full dosage, assuming one dose might be good enough. This is a recipe for a conversation that will either simply not work all that well, with the doctor and patient potentially talking at cross purposes for a fairly significant proportion of the precious time available.
Understanding each other’s perspectives, or mental schema, is one way to make the session operate more effectively: with that in mind, patients typically wait for at least 20 minutes before seeing a doctor, time that doctors could learn more about their patients. A simple questionnaire could be completed in the waiting room that would allow the doctor to more quickly see the mental schema that their patient had about vaccination. This can allow them to tailor the way they talk about the issue, facilitating a much more effective conversation.
Of course, no conversation will be effective if one of the parties does not trust the other: in the case of the doctor and patient then it is important to be in a position of the patient trusting expert advice. As we know from our everyday lives, trust can take time to build but there are things that can help in the moment: showing feelings, admitting mistakes, being respectful and open and communicating carefully are all small but important ways in which trust can be garnered in the moment.
One final consideration is mental preparedness – if the doctor has the opportunity to reflect on the lessons of previous interactions with the patient, they are in a much better position to reset their own mental schema on how best to engage. The intense time-limited nature of many experts working lives, particularly doctors, mean this can be a challenge but nevertheless an important one given the central role of the expert interaction for delivering on desired outcomes.
Much of the time interventions in behavioural science are thought about in terms of communications but there is a much wider repertoire available. In a wide range of both public and commercial sector challenges that we tackle, talking to someone with expertise on a topic is critical to behaviour change. Tackling the ‘Donal Rumsfeld question’ is an important part of making this a success rather than people simply talking at odds with each other.